Breast cancer risk status influences uptake, retention and efficacy of a weight loss programme amongst breast cancer screening attendees: two randomised controlled feasibility trials

Abstract

BackgroundExcess body weight and sub-optimal lifestyle are modifiable causes of breast cancer and other diseases. There is little evidence that behaviour change is possible within screening programmes and whether this is influenced by prior knowledge of disease risk. We determined whether breast cancer risk influences uptake, retention and efficacy of a weight control programme in the UK National Health Service Breast Screening Programme, and whether additional cardiovascular disease and type 2 diabetes risk information improves uptake and retention further.MethodOverweight/obese women in the UK National Health Service Breast Screening Programme identified at high, moderately increased, average and low-risk of breast cancer were randomised to receive individualised breast cancer risk information (breast cancer prevention programme), or individualised breast cancer, cardiovascular disease (QRISK2) and type 2 diabetes (QDiabetes, HbA1c) information (multiple disease prevention programme). Personalised breast cancer risk feedback was given before randomisation in Study-1, and after randomisation in Study-2.ResultsRecruitment was 9% (126/1356) in Study-1 and 7% (52/738) in Study-2. With respect to breast cancer risk, odds ratio of uptake for high/moderately increased vs low risk women was 1.99 (95% CI 1.24–3.17, P = 0.004) in Study-1 and 3.58 (95% CI 1.59–8.07, P = 0.002) in Study-2. Odds ratio of retention for high/moderately increased -risk vs. low risk women was 2.98 (95% CI 1.05–8.47, P = 0.041) in Study-1 and 3.88 (95% CI 1.07–14.04, P = 0.039) in Study-2. Weight loss of ≥5% at 12 months was achieved by 63% high/moderate vs. 43% low-risk women in Study-1 (P = 0.083) and 39% vs. 8% in Study-2 (P = 0.008). Uptake, retention and weight loss were equivalent in both the breast cancer prevention programme and the multiple disease prevention programme in both studies.ConclusionsWomen who are informed that they are at increased breast cancer risk were significantly more likely to join and remain in the programmes and consequently lose more weight across both studies. High risk women are more likely engage in a lifetyle prevention programme and also have the greatest potential benefit fom risk reduction strategies.Trial registrationISRCTN91372184 Registered 28 September 2014.

Dutch women’s intended participation in a risk-based breast cancer screening and prevention programme: a survey study identifying preferences, facilitators and barriers

“…Around one third of our survey participants would like to receive help from a dietician, with significantly more women with a higher BMI preferring professional help. This is in accordance with results from the PROCAS lifestyle study, which offered two weight control programmes to overweight or obese women in the UK National Health Service Breast Screening Programme (NHSBSP) identified at low, average, moderately increase or high-risk of breast cancer [23]. They found that women who were informed to be at increased risk of breast cancer were more likely to join and remain in the programmes.…”

“…They found that women who were informed to be at increased risk of breast cancer were more likely to join and remain in the programmes. These women consequently lost more weight than women who were not at increased risk [23]. Women with a first degree family history of breast cancer appear less interested in changing their dietary and exercise habits.…”

Testing a Breast Cancer Prevention and a Multiple Disease Prevention Weight Loss Programme Among Women Within The UK NHS Breast Screening Programme - A Randomised Feasibility Study

“…This feasibility study highlights potential strategies to increase recruitment to weight loss programmes within the NHSBSP. Firstly, focussing on women at high or above average BC risk who had uptakes of 14-20% compared to 4-10% for women at average or low BC risk reported herein and previously within this cohort (36). Higher risk women will also derive a greater absolute risk reduction from changes in health behaviours compared to low risk women.…”

Personalized early detection and prevention of breast cancer: ENVISION consensus statement

“…Finally, strategies should be developed to increase the acceptability and accessibility of interventions used for breast cancer prevention. Notably, the efficacy of weight loss programmes has been shown to be greater among individuals who are aware of being at high risk of developing breast cancer 143 . Importantly, weight loss 144 and regular exercise 145,146 not only decrease breast cancer risk but also the risks of other cancers and CVDs.…”

“…Indeed, a methodical review of nine systematic reviews, encompassing at total of 36 unique studies, revealed no evidence that providing risk information would have strong, consistent or sustained effects on behaviour 186 . Changes in health-related behaviour can, however, be facilitated by including elements of interventions to alter the behaviour in question 143 .…”